Cancellation and short postponement of primary hip or knee arthroplasty does not influence postoperative joint specific function or health related quality of life

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Abstract
Purpose The effect of cancellation and postponement of primary total hip arthroplasty (THA) or knee arthroplasty (TKA) on patient outcomes is unclear. The aim was to assess whether cancellation and delay to arthroplasty was associated with worse joint specific function and quality of life (QoL) 1-year postoperatively. Methods A single centre retrospective case–control study was performed for all patients planned to undergo THA or TKA in 2019. A total of 3133 arthroplasties were scheduled for 2019 (1484 THA, 1649 TKA), of which 344 (11.0%) were cancelled (136 THA [9.2%], 208 TKA [12.6%]). Pre-operative and one-year post-operative EuroQol (EQ-5D) and Oxford hip (OHS) or knee (OKS) scores were collected. Results The median time between the date of cancellation and the subsequent operation was 46.0 days for TKA and 45.5 days for THA. The cancelled group were more likely to be male (odds ratio [OR] 1.23, p = 0.03), older (mean difference [MD] 1.19, p = 0.03), with a higher ASA grade (OR 1.88 [ASA 3], OR 5.3 [ASA 4], p = 0.001) or planned for a TKA (OR 1.41, p = 0.003). There were no differences in pre-operative OKS (mean difference [MD] 0.19, p = 0.828) or EQ-5D (MD 0.028, p = 0.394) or in the one-year postoperative OKS (MD 1.51, p = 0.064) or EQ-5D (MD 0.041, p = 0.067) between groups undergoing TKA. However, cancelled THA patients had lower pre-operative OHS (MD 2.73, p = 0.018) and EQ-5D (MD 0.134, p = 0.0017) but at one-year postoperatively there was no difference in the absolute OHS (MD 2.07, p = 0.052) or EQ5D (MD 0.04, p = 0.142). The improvement in hip EQ-5D was greater (MD 0.096, p = 0.016) in the cancelled group. Conclusion Cancellation and short delay did not influence joint specific outcome or QoL following THA or TKA at one-year. Preoperative hip specific pain, function and QoL were worse in cancelled THA patients, suggesting deterioration while waiting for their surgery, but this did not affect their postoperative outcome.

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